Provider Demographics
NPI:1831509322
Name:TUCKER, NATASHA TAMIKA (NP)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:TAMIKA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:TAMIKA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-560-7070
Practice Address - Fax:864-560-7033
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01391568OtherRAILROAD MEDICARE
SCNP2761Medicaid
SCSC32527628Medicare PIN